Table 4.

Issues related to health service encounters raised by chronically ill patients, and suggestions of patients, carers and health care professionals for overcoming them

Challenges raised by participants	Patients’ and carers’ suggestions	HCP suggestions and solutions
•Communication and delivery of information
Inadequate explanation of illness, prescribed medication and side effects	HCPs provide patients with a written care plan in plain language	Improvement of health literacy
Confusing and conflicting information provided	Professional organisations endorse guidelines	Better communication between different professional groups
Practical examples of appropriate diets and concepts not provided (e.g., Glycemic Index)	NS	NS
Lectures given by HCPs seem pointless	More interactive learning experiences such as support groups	Improved communication between patients and HCPs
No explanation given about the side effects of medication	NS	Enhanced information technology infrastructure
No help provided in accessing internet	NS	Enhanced information technology infrastructure
CALD participants want information in their own language	GPs increase their awareness of cultural issues and exercise care in providing information to CALD patients	Improved communication between professionals and CALD groups
HCP seen as inflexible and unaccommodating	NS	Need to improve accountability between service providers
Outdated information about disease management	NS	Enhanced information technology infrastructure
Insufficient information about community resources provided	Provide access to relevant data bases	Better co-ordination of care
Poor communication by interns	Improved supervision by specialists before diagnosing conditions with a poor prognosis such as cancer	Need to improve accountability between service providers
•Organisation of service delivery and waiting time to see HCP’s
Arranging appointments in urgent situations	On call doctors to give information and directions	Need to reduce communication gaps
Arranging appointments when new symptoms appear	Electronic booking systems	Enhanced electronic infrastructure
Long waiting time to make appointments and delays in seeing HCPs	Phone or SMS patients to inform them of possible delays	Need to reduce communication gaps
Inflexible appointment times	Greater flexibility	NS
Rigid eligibility criteria which exclude some people from inpatient or outpatient care	Revision of eligibility criteria of services to ensure they cover patients at different states of disease	Need to improve communication between various service providers
•Facilitation of self care
Insufficient support for self-care	NS	NS
Insufficient written information about what to do in different conditions	Handbooks and disease specific information packages	Enhanced communication
Insufficient follow up and monitoring of patient’s condition as well as new symptoms	GP’s and case coordinators follow up, from hospital or private health insurance	Need to improve co-ordination of care by service providers
•Single illness focus
GPs and specialist focus only on the immediate symptoms and conditions	Holistic approach to patient’s conditions with careful review of medical history	Need to improve fragmentation of services
•Inclusion of patients and carers in decision making
Lack of trust in patient’s knowledge and understanding of signs and symptoms	NS	Need to improve health literacy
Patients don’t feel hopeful and motivated about the future	Provide up to date information and review of the latest developments in lay language	Need to improve patients’ focus on management of conditions
Failure to ask patients about their tolerance of available treatments		Be sure to ask patients about any tolerance or compliance issues before prescribing medications

HCP: Health Care Professional, NS: No suggestion, CALD: Culturally and Linguistically Diverse.